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Author for correspondence: Wolfgang Gaebel, E-mail: [email protected]
Development of the term and concept of schizophrenia: a brief overview
Early descriptions of the symptoms of a syndrome which we still call ‘schizophrenia’ since more than 100 years can be traced back to thousands of years ago (Tandon et al., 2009). However, the modern concept and name of schizophrenia were shaped in the early 20th century when the Swiss psychiatrist Eugen Bleuler (1911) introduced the term as an extension and replacement for what was formerly coined ‘dementia praecox’ by Emil Kraepelin (1896). The psychoanalytically inspired intention behind the new term was to cover the observed deconnection of psychic functions among personality, thinking, memory and perception, which Bleuler assumed to be the prominent feature of the illness. He intended to introduce a broader disease concept and spoke of ‘the group of schizophrenias’, undermining his understanding of a heterogeneous group of diseases with different aetiopathogenesis, course and outcome – thereby introducing a much more positive prognostic concept instead of the single Kraepelinian disease entity with deleterious outcome. Bleuler made a distinction between primary and secondary symptoms, the former assumed as being closer to the underlying neurobiology, as well as fundamental and accessory symptoms (Bleuler, 1911).
Subsequently, Kurt Schneider, a pioneer by introducing operationalisation into psychiatric classification, defined first-rank symptoms and second-rank symptoms and hypothesised the former being indicative of the presence of schizophrenia (Schneider, 1967). Due to their clear definition and expected diagnostic value, these core symptoms were incorporated in the later versions of classification systems on mental and behavioural disorders being developed since the middle of the 20th century (Tandon et al., 2009).
Although in the major classification systems ICD (International Classification of Diseases) and DSM (Diagnostic and Statistical Manual of Mental Disorders) the name of schizophrenia has been kept since its introduction, the diagnostic concept has undergone several revisions in the decades following. Over time, the concept varied between broader or narrower definitions (Tandon et al., 2009) with resulting better or poorer outcomes (Hegarty et al., 1994). Reliability of operationalised diagnostic categories improved considerably (Keeley et al., 2016), but the validity of the concept itself still remained elusive. Accordingly, schizophrenia is still classified among the mental and behavioural disorders and not...